| NPI | 1669429692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MARIE COFFMAN Administrator 330-929-0671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-08-22 |